Student Record Request Form

Student Record Request Form

9660 E. Hwy 71 Spicewood,TX 78669 Phone: (830) 220-5226
Office@scatx.org
School District
Campus
Registrar Email of previous school
example@example.com
City, state
Request From:
Email
example@example.com
Student Name
Date of Birth

MonthDayYear
Date
A transcript of grades (if applicable)Cumulative RecordsTAKS ResultsCopy of the most recent report cardImmunization RecordsCopy of Birth CertificateCopy of special education records/plans, testing, 504, IEP, APE, and ALL information.All of above (Please check this box K-8th)
A transcript of grades (if applicable)Cumulative RecordsTAKS ResultsCopy of the most recent report cardImmunization RecordsCopy of Birth CertificateCopy of special education records/plans
Confidentially Notice The records from Spicewood Christian Academy contains information that is confidential or privileged or both. This information is intended only for the use of the individual or entity named on this request. Any disclosure, copying, distribution or use of this information by any person other than the intended recipient is 4439.prohibited. If you have received these records in error, please notify us by telephone immediately at (830) 220- 5226.
Parent/Guardian filling out form:
Parent Signature
Should be Empty: